Delay of Medication Administration for New and Re-Admissions in Nursing Facility
Patients being transferred to a nursing home after an acute hospitalization are subject to medication omission related to ineffective coordination of care across settings (Ward et al., 2008). Studies of medication-related errors and adverse drug event in sub-acute nursing facility (SNF), also known as long term care (LTC) have found that residents are at greatest risk of medication errors during care transition periods to the nursing home after a hospitalization (Sandi, 20113). Many were dose omissions related to delay of medication ordering, and delay pharmacy dispensing and delivery. Medication errors ...view middle of the document...
CDC medication error report indicated age group 65 years or older has the highest medication errors rate totaled 12, 926 reported cases in 2004 (CDC, 2008). To meet this standards, LTC facility needs to establish a consistent, safe, and dependable system to ensure residents receive their medication timely.
Registered nurse must promptly perform their assessment and communicate hospital's recommendations to the physician, obtain orders, and submit them to the pharmacy for dispensing. This process can take up to 2 hours, given no other emergency interruption during the process. Nursing facilities must provide routine and emergency drugs and biologicals to its residents. When an emergency drug such as antibiotics, anticoagulant, respiratory or seizure medication is believed undeliverable before the next dose, the registered nurse must check the emergency box for availability. Because the amount of emergency drugs can be stored in a facility is restricted by law, unavailable medications such newer drugs will be communicated to the physician to seek for alternatives, if possible, otherwise, the physician will determine if the medication can be held temporary, and the resident will be monitored for any adverse effect during the waiting period. If the medication must be administered, a contracted local pharmacy will be notified to provide the emergency supplies. It is recommended that the nurse who admitted the new resident to communicate with the pharmacy to confirm order receive and time or arrival.
There are many factors that delay new admission medication administration. Unexpected emergencies during admission process, on-call physician respond time, non-covered medication and medication clarification, and delay delivery due to poor weather condition or traffic. Health care managers first need to define what constitutes an error within their organization (Pape, 2001). Nursing administration should determine what system, rather than what person, cause the error.
CMS Regulations For Specialized Pharmacy Services
The Medicare Modernization Act of 2003 recognizes that beneficiaries who reside in long term care facilities have needs for specialized pharmacy services, have access to a pharmacist 24 hours per day, seven days per week, and emergency deliveries of medication to assure residents receive timely access to appropriate medication therapies (CMS, 2014). In order to meet these special needs, many nursing facilities contract with a long-term care pharmacy (LTCP) to provide prescription drugs and consultant services. Standards of practice for LTCP have evolved over several decades in response to a complex set of Federal and state regulations governing the provision of prescription drugs in the LTC setting (CMS, 2014).
The regulations governing the practice of pharmacy in nursing facilities are designed to protect the health and safety of nursing facility residents. Nursing facility residents have special care needs that in...